I have spent more time Googling John McCain’s VP pick Sarah Palin this weekend than studying. Mostly because I didn’t know much about her. (I could say the same for McCain, apparently.)

I am going to mostly keep above the fray. First of all, because there is a perfectly wonderful article written about her, scandal wise and the shame of it all, by Rebecca Traister at Salon.com. Other political journalists are covering her political gaffes and convenient contradictions, of which there have already been many.

What I wanted to talk about has something to do with the pregnancy (sorry, Rebecca, I can’t resist talking about the uterus.) I don’t want to talk about any rumors about her pregnancy, or cast any shame on her daughter. Strictly from an obstetrical point of view, I want to take her version of her labor and delivery with Trig at face value and trust her. Trust her to tell the truth, maybe. But trust her judgment if it is indeed true?

Palin was in Texas last week for an energy conference of the National Governors Association when she experienced signs of early labor. She wasn’t due for another month.

Early Thursday — she thinks it was around 4 a.m. Texas time — she consulted with her doctor, family physician Cathy Baldwin-Johnson, who is based in the Valley and has delivered lots of babies, including Piper, Palin’s 7-year-old.

Palin said she felt fine but had leaked amniotic fluid and also felt some contractions that seemed different from the false labor she had been having for months.

“I said I am going to stay for the day. I have a speech I was determined to give,” Palin said. She gave the luncheon keynote address for the energy conference.

Palin kept in close contact with Baldwin-Johnson. The contractions slowed to one or two an hour, “which is not active labor,” the doctor said.

“Things were already settling down when she talked to me,” Baldwin-Johnson said. Palin did not ask for a medical OK to fly, the doctor said.

“I don’t think it was unreasonable for her to continue to travel back,” Baldwin-Johnson said.

So the Palins flew on Alaska Airlines from Dallas to Anchorage, stopping in Seattle and checking with the doctor along the way.

“I am not a glutton for pain and punishment. I would have never wanted to travel had I been fully engaged in labor,” Palin said. After four kids, the governor said, she knew what labor felt like, and she wasn’t in labor.”

Still, a Sacramento, Calif., obstetrician who is active in the American College of Obstetricians and Gynecologists, said when a pregnant woman’s water breaks, she should go right to the hospital because of the risk of infection. That’s true even if the amniotic fluid simply leaks out, said Dr. Laurie Gregg.”

Uh, excuse me? Her water was leaking, she was feeling contractions, and she has had four previous children, and she delivered a speech and then took TWO airplane flights and then DROVE past hospitals with NICUs to go to her small town doctor? I can’t believe she flew at 36 weeks, even without contractions and ruptured waters!

Not only is there the risk of infection, but broken waters and contractions are usually the sign of progressive labor, even if the contractions aren’t frequent. Once the membranes are ruptured, 90% of women are in active labor within 24 hours, and most women deliver within that time. Especially a multip (a woman who has had several children before.) There is no way her doctor in Alaska could tell over the phone if Palin’s waters were indeed ruptured or if she was dilating.

Any health care practitioner worth her license would have advised her to immediately go, get a test with Nitrazine paper to see if her membranes were indeed ruptured, and get a vaginal check to see how much she was dilated.

Palin and her doctor both apparently knew the baby had chromosomal abnormalities and may have been born with serious defects, which are common in babies with Down Syndrome. What if she gave birth on the plane? She didn’t even alert the airline that she was pregnant, much less 8 months pregnant, with broken waters and contractions and a baby with known abnormalities. Any mother with premature rupture of membranes should be treated as an emergency, and this pregnancy had the extra twist of the Down diagnosis.

This is a glaring example of extremely poor judgment. This is the sort of anti-science, anti-thinking, headstrong nonsense that has embroiled our country for the last eight years. We don’t need a vice president (or president, for that matter) who thinks mother’s intuition and her faith are more important than appropriate medical standards of care. This is an extreme situation. She was the governor when she behaved like this, and put her life and the life of her son recklessly in danger. Not to mention, she put the other passengers and employees of the flights she was on in an unfair position. And according to her, she had no compelling reason travel from one end of North America to the other. She did have a compelling reason to get to a hospital as soon as possible.

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18 responses to “The Palin stuff”

As a hyper-parent; as someone who took very little risk medically with my pregnancy and with my child’s health – this, this made me hyperventilate, hand at throat, eyes bugging out. I could not fathom the kind of person who would do this. Risk this. It lends credence to the rumors that she didn’t actually gestate this baby. And I wondered, couldn’t that kind of infection kill her too, not just the baby?

I know. It sounds ridiculous for the governor of a state to think she could get away with faking a pregnancy. But what is more bizarre, that or the truth? Sure sound more like a mother rushing home to her daughter’s birth than a pro-life pregnant woman.

Well, Becca, excessive vaginal exams can increase risk of infection once waters are broken, but that vagina is hardly sterile. One exam with nitrazine paper to confirm whether the waters are broken may not be more of a risk than having them broken for a long period of time. Length of time after the waters are broken is a big factor in rates of infection. In fact, having your membranes rupture prematurely may be a sign of an infection that is already occurring.

What I am more concerned with than the infection risk, which is real, is the speed at which a woman, especially a fifth time mother, can go into labor once her waters are broken. Sarah Palin was not necessarily wise about not being in labor, she may have just been extremely lucky. She embarked on a twelve hour set of flights.

My first catch was a fifth time mom. She had been stalled out for a while, her waters were broken. We were reaching the 24 hours mark without any sign of imminent delivery, and were getting ready to transfer her from the birth center, which was in accordance with Florida law. (Yes, the risk is real). As we were packing, she got a few strong contractions, dilated 5 centimeters and delivered within half an hour. I barely had time to get my gloves on.

How about, “It is her baby, her body, her business”? How about three cheers to the doctor who didn’t provide a knee-jerk, ass-covering response (i.e. OMG go to the hospital RIGHT NOW and get checked!) and who trusted the experienced birthing woman to know her body? How about her sacred right to blow off “accepted medical standards” in favor of her own (correct) intuition and knowledge of her body?

For goodness sake Hilary, next thing I know you’ll be jumping all over someone’s ass for having an illegal HBAC instead of listening to ACOG, being a good girl and getting her unnecessarean.

I am not going to vote for Ms. Palin, but I sure as hell am not going to judge her for how she chooses to live her life in regards to reproduction and birth.

AND I would NOT recommend a vaginal exam for PROM in this situation. I guess I’m not worth my license, but so be it.

I wouldn’t judge her as much for rejecting a vaginal exam an a nitrazine test if she was in the place she was planning on giving birth. Boarding two flights, one that was cross country and one that was over Canada is not the same thing. I don’t think it is a knee jerk, ass covering response at all. 80% of women are in active labor by the 24 hour mark after their waters break, and most of them have delivered by then.

This was not the same as her other births. She was not on a plane from Texas to Alaska during her labors before, as far as I know, and none of her previous children have chromosomal abnormalities that are associated with heart defects.

I am all for choice and alternative births, but defending unsafe activities does not do much for the cause.

Who gets to decide what’s safe? You? ACOG? The Anchorage Daily News? Or the woman whose body and baby it is?

She decided it was safe, and lo and behold, everyone survived just fine. She was right, it WAS safe, in her situation at that time. Even if something bad had happened to the baby or to her, it STILL would have been her right to make that decision.

There is an element of risk in every. single. thing. we. do. She decided to take certain risks over others. That is her right, and I’ll stand up for it.

Well, everyone of these entities you listed has a place in judging safety. I would judge this as unsafe behavior as a practitioner when I become one. Considering women have been arrested and forced to have cesareans when their waters are broken (not that I defend this practice), I think this case is clearly notable.

People have the right, arguably, to determine their own medical treatment. You know as well as I do if her waters were broken at a birth center or home birth in Florida, it would have been illegal to keep her past the 12 hour mark if she was not in active labor or after the 24 hour mark if delivery was not imminent. The midwife and birth center could lose their licensure otherwise. If there was a woman in this situation (not on an airplane), she could conceivably decide what she thinks is safe based on her own limited knowledge, but in many cases, medical standards of care and even law may say it is not safe. At the birth center these women would have had a nitrazine test and would have been administered antibiotics. And that isn’t even considering the airplane!

Again, I have seen people fight tooth and nail to defend against interventions in every single situation, and I think it does nothing for the cause of natural birth to do so. If its defenders look irrational, it does nothing for the cause.

If you really think a woman, a grand multip at that, with a fetus with known chromosomal abnormalities, with probable ROM and preterm labor should wait 12 hours, then get on a plane and travel for 12 more hours without any medical attention, that is your call. I see it as bad medicine on her doctor’s part and bad judgment on her part. The fact it turned out OK for her means nothing to me. One case study of turning out OK does not refute evidence that most women would have delivered in her case. There was a child born on an airplane just this month that I read about.

You don’t have to agree with me, but I am not having a knee jerk reaction based on anyone’s definitions of safety other than my own knowledge on the subject. I think you are ignoring the two airplane flights that are part of this equation. We are not talking about a low risk candidate with a practitioner with her.

One last thing, and I will go back to studying. Notice that I never said it was not her “right” to make this decision. I said it was bad judgment. I think people have the right to refuse all sorts of medical care. Is it always good judgment? Of course not. If a aunt who is Jehovah’s witness could refuse to allow her adopted nephew to get a blood transfusion, and let him die before her eyes is within her legal boundaries (as happened last year) then rights to refuse care are wide.

Is that good judgment? Is it good medicine? Would I want that aunt deciding national health care policy? No.

Right, I think it was certainly her choice, it just strikes me as a particularly unusual one. I think it’s one thing, for example, to choose a home birth, as emergency medical care can be summoned if needed (for woman or baby). On planes, however, there is no possibility of emergency back-up. When we look at electing our leaders, we look at the choices they’ve made, at how they’ve been able to assess and respond to situations. Her assessment and response in this incident, while hers to make, is one that I have difficulty understanding.